| NPI | 1184645277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 45483) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101247294) |
| 207P00000X Emergency Medicine (Licence: NC 2006-01042) | |
| 207R00000X Internal Medicine (Licence: TN 45483) | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2025-06-04 |